Changes in Health Insurance Coverage2000-2010

John HolahanVicki Chen

Alliance for Health ReformOctober 14, 2011

What happened to insurance coverage in 2010?• In 2010, the uninsured increased by 800,000. The rate of

employer-sponsored insurance declined in both adults and children by about 0.7 percentage points.

• Medicaid and CHIP coverage increased for children but not for adults

• The number of uninsured increased for adults but not children

• Young adults (19-25) saw significant increases in private coverage and their uninsured rate declined from 31.7% to 30.0%. Other age groups either had no change or had declines in private coverage and increases in their uninsured rates. This seems very likely to be the effect of the Affordable Care Act.

2

Percentage Point Changes in Health Insurance Coverage of Adults, Various Ages, All Incomes, 2009-2010

19-25

3*percentage point changes are significant at the .05 level

26-34 35-54 55-64

Change in Population

Change in Uninsured

0.3 Million

-0.4 Million

0.1 Million

0.3 Million

-1.5 Million

0.4 Million

0.8 Million

0.6 Million

Changes in Unemployment Rates

The 2000-2010 period began with a recession that was followed by declining unemployment and a modest recovery. The “Great Recession” began in 2007 and officially ended in June 2009.

4

Changes in Real Personal Incomes, 2000-2010

Real incomes fell between 2000 and 2004, then grew slightly between 2004 and 2007. With the recession, real incomes again declined.

5

6

Net Growth in Population

Virtually all the net change in population between 2000 and 2010 was among those with incomes below 200% FPL.

Source: Urban Institute, 2011. Based on data from the 2001-2011 ASEC Supplement to the Current Population Surveys.

Change in Coverage Among Adults, 2000-2010Coverage Rates

Employer Sponsored Insurance

Medicaid - State Uninsured

Millions of Uninsured

2000 70.6% 4.8% 16.5% 27.8

2004 65.9% 6.5% 18.8% 33.3

2007 65.2% 6.7% 19.1% 34.9

2010 60.4% 8.1% 22.0% 41.2

7

Among adults, employer sponsored insurance declined and the number of uninsured grew, even in the period of economic growth.

Change in Coverage Among Children, 2000-2010

Coverage Rates

Employer Sponsored Insurance

Medicaid - State Uninsured

Millions of Uninsured

2000 66.7% 16.5% 11.1% 8.5

2004 62.0% 21.8% 10.3% 8.0

2007 59.8% 23.5% 10.9% 8.6

2010 55.0% 29.1% 10.0% 8.0

8

The number of uninsured children actually fell over the decade; while employer coverage fell sharply, public coverage expanded.

Percentage Point Changes in Health Insurance Coverage of Adults and Children, All Incomes, 2007-2010

Adults Children

Change in Population

Change in Uninsured

3.9 Million

6.3 Million

0.6 Million

-0.6 Million

9*percentage point changes are significant at the .05 level

Adults Children

Change in PopulationChange in Uninsured

10.1 Million

5.6 Million

3.9 Million

-0.2 Million

10

Percentage Point Changes in Health Insurance Coverage, Low Income (<200%FPL) Adults and Children, 2007-2010

*percentage point changes are significant at the .05 level

Percentage Point Changes in Health Insurance Coverage, by Family Work Status, 2007-2010

Change in Population

Change in Uninsured

-7.2 Million

-0.4 Million

6.2 Million

2.4 Million

9.2 Million

3.6 Million

11*percentage point changes are significant at the .05 level

-3.8 Million

0.0 Million

One Full Time Worker

Two Full Time Workers

Part Time Workers No Workers

Other Findings (2007-2010)

• Almost 60% of the increase in the number of uninsured was among whites, in line with their share of the population

• Almost 85% of the increase in the number of uninsured was among native citizens; non citizens were only a very small share of the growth

• The increase in the uninsured was distributed across all regions. The south continued to have the highest uninsured rate and had the largest increase in number of uninsured

12

• Long standing secular decline in ESI, exacerbated by economic downturns

• Slow increases of public coverage among adults, greater expansions for children; public coverage limited the increase in uninsured

• Increases in number of uninsured concentrated among adults, and among those losing full-time work

• Young adults seem to have benefited from the health reforms introduced in 2010, seeing gains in private coverage while other age groups saw declines

• Health reform will end link between ESI and uninsured by expanding Medicaid and providing tax credits in exchanges

13

Conclusions